1. EFFECTIVENESS OF
INTERMITTENT PREVENTIVE
TREATMENT OF MALARIA IN SUB-
SAHARAN AFRICAN INFANTS.
BY
MUKHTAR .A. IJAIYA

2. The Burden of Malaria
In 2010, approximately 216,000,000 episodes
of malaria was recorded worldwide with
655,000 deaths.
Africa accounts for an estimated 81% of the
incidence rate and 91% of the mortality rate.
An African child under five dies of malaria
approximately EVERY MINUTE.
(WHO 2011a)

3. MALARIA
 Preventable and Curable.
 Caused by Plasmodium Species.
 Transmitted by the Vector; Anopheles Mosquito.
 High Risk persons: Young Children, Pregnant
Women, Persons living with HIV/AIDS, Travellers
from non endemic areas to endemic areas.
 Diagnosed by parasitological examination in the
laboratory or with rapid test kits.
(WHO 2012)

4. MALARIA
 Symptoms: Fever, Headache, Chills, Nausea,
Vomiting (Dale et al, 2007).
 Severe Malaria further presents : Severe
anaemia, Respiratory distress, Shock, Multiple
Organ Failure (Goldsmith 2006).
Prevention: Mainly directed at Vector Control
and Chemoprevention (WHO 2012).
 Treatment: WHO (2005) recommends
Artemisinin based Combination Therapy (ACT).

5. REASONS FOR THE HEAVY
MALARIA BURDEN IN SUB-
SAHARAN AFRICAN INFANTS.
 Predominance of the deadly Plasmodium
falciparum strain (WHO 2008).
 Long lifespan and strong human biting habit
of the African vector species (WHO 2012).
 Favourable climatic conditions (WHO
2012).
 Poor Socioeconomic factors/indices (WHO
2008, UNDP 2012)
 Lack of acquired protective immunity in
infants (WHO 2008).

6. CURRENT MALARIA CONTROL
PROGRAMME.
 Africa Roll Back Malaria partnership which
involves:
Proper organization and management of health
systems.
Improved disease management.
Provision of antimalarial drugs with malaria control
related materials.
Increased disease prevention and disease
surveillance.
Epidemic preparedness and response.
Human resources development.
Legislative action and sustainable control

7. INTERMITTENT PREVENTIVE
TREATMENT IN INFANTS (IPTi).
 Intermittent preventive therapy in infants involves
administering to infants at specific time points, a
complete course of an effective antimalarial
medication with the objective of reducing the infant
malaria burden regardless of whether they are
parasitaemic or not (WHO 2009).
 The infants should receive the anti malaria drug
administration with routine vaccinations in their first
year of life with exact timing dictated by the
country’s immunization schedule (WHO 2011b).
 The WHO (2009) recommends Sulfadoxine-
Pyrimethamine (SP) as the Drug of Choice.

8. TRIALS
 Amponsa-Achiano et al (2005), used SP
with iron supplementation for IPTi in Ghana.
 Incidence rates of mild to moderate malaria
and anaemia declined.
 No effect on severe malaria and mortality
rates.
High density of Parasitaemia some months
after IPTi, suggesting rebound morbidity.
Verhoeff and West (2003), severe anaemia
controlled by malaria control and iron
intake.

9. TRIALS
 Adjei et al (2009) pooled analysis of six
trials in African infants using SP.
 Reduction in clinical malaria, hospital
admissions and anaemia incidence rates.
 No effect on mortality rates, no adverse
effects, no interaction with vaccines and no
rebound morbidity seen.
 Mildly effective in areas of high parasite
resistance and greater efficacy when
combined with the use of bednets.

10. TRIALS
 Carneiro et al (2009), safety and efficacy
of three regimens for IPTi in an area of
high SP parasite resistance.
 SP, well tolerated but not significantly
effective.
 Mefloquine, highly efficacious but badly
tolerated.
 Chlorproguanil-Dapsone, not effective
and caused an increased risk of anaemia.

11. TRIALS
 Alexander et al (2006), combined use of
artesunate and SP for IPTi in African
Children.
 Impressive amount of protection
conferred.
 Infants showed a stronger persistent
protective effect.
 No rebound morbidity observed.

12. TRIALS
 Akida et al (2003), used Amodiaquine for
IPTi in Tanzanian infants.
 Decrease in incidence of clinical malaria.
No rebound morbidity observed.
Well tolerated but previously
documented adverse reactions remained
an issue.

13. TRIALS
 Breman and Rosen (2004) and Crawley et al
(2012) have noted that IPTi has no impact
whatsoever on immune responses to
vaccines.
Widespread efficacy of IPTi depends on the
coverage rates of the Expanded programme
on immunization (Kruger 2004).
Alonso et al (2009), calculated and found
IPTi to be a highly cost effective intervention
in African infants.

14. CONCLUSION.
Sulfadoxine-Pyrimethamine (SP) for IPTi
should be included in existing malaria
prevention strategies in areas of low
parasite resistance and a greater
emphasis placed on improving
socioeconomic conditions.

15. REFERENCES.
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